Kounis Syndrome Associated With the Use of Diclofenac

Case Report: Flurbiprofen-induced Type I Kounis syndrome

Background

Kounis syndrome is a specific type of acute coronary syndrome caused by allergic or hypersensitivity response. Clinical knowledge about this syndrome is insufficient. We report a case in which intravenous administration of flurbiprofen resulted in Type I Kounis syndrome.

Case summary

A 60-year-old female patient with no history of coronary artery disease developed limb erythema, hypotension, and chest tightness after receiving intravenous flurbiprofen. Electrocardiogram showed ST segment elevation in leads II, III, and aVF. Emergency coronary angiography revealed no significant stenosis or thrombus in the coronary arteries. Subsequent echocardiography showed no apparent abnormalities. Levels of troponin T were elevated. The diagnosis was flurbiprofen-induced Type I Kounis syndrome, presenting as acute ST segment elevation myocardial infarction.

Conclusions

Patients with Kounis syndrome can exhibit severe clinical symptoms, and their condition may even be life-threatening. It is important for clinicians to have a thorough understanding of this syndrome in order to develop comprehensive treatment plans.

Cardiac Arrest Due to Kounis Syndrome Following Cephazolin Administration During Surgery Under Local Anesthesia

The Kounis syndrome is described as the co-occurrence of allergic responses brought on by mast cell activation and acute coronary syndromes. We present a case of Kounis syndrome leading to cardiac arrest following the cephazolin sodium administration during the surgical resection of basal cell carcinoma. An 87-year-old woman was diagnosed with basal cell cancer. She received surgical excision of the tumor while anesthetized with lidocaine hydrochloride and 1% epinephrine. This patient began to itch around five minutes after cefazolin (CEZ) administration and eventually experienced cardiac arrest following diffuse rashes that spread throughout her body and edema in her eyelids. In line with the response, the electrocardiogram (ECG) also showed an elevated ST segment in V1-6, leading to possibly the diagnosis of Kounis syndrome. We also review the literature on Kounis syndrome following CEZ administration.

Drug-Induced Kounis Syndrome: Latest Novelties

Kounis syndrome (KS) is defined by an acute coronary syndrome associated with hypersensitivity reactions, an under-diagnosed life-threatening medical emergency. Although multiple causes have been described, drugs constitute the most frequent cause. The purpose of this review is to update knowledge about drug-induced KS, to give guidelines on the correct diagnosis and treatment. This article reviews the literature on drug-induced KS from the last 5 years. Antibiotics and NSAIDs are the most frequently implicated drugs. In addition, data on pathophysiology, clinical presentation, diagnosis, and management are reviewed in detail. Highlight that there is a great deal of variability in the diagnosis and especially in the treatment of KS. This review provides a valuable selection of practical resources for all stakeholders to support effective care for KS, from a cardiologic and allergologic point of view. Future research should focus on developing validated, evidence-based, and patient-centered tools to improve the management of KS.